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It’s been five months since Hurricane Maria hit Puerto Rico and wiped out houses, roads and the power grid, as well as factories that make prescription drugs and medical devices.

Around 80 of these health care companies make their products on the island. That includes those small IV bags hospitals use to deliver chemotherapy or antibiotics to patients. And the nationwide shortage of these IV bags is still affecting health providers in Kentucky.

In a small room at Baptist Health hospital in LaGrange, these popsicle-sized bags hang on a pole. Pharmacy techs here take tiny amounts of chemotherapy drugs and mix them with saline. That fluid then goes in an IV bag.

Pharmacy Director Angela Sandlin said the shortage hasn’t affected patient care at this hospital, but it has affected the time her staff has to spend tracking down bags.

“Our primary cost has been time,” she said. “It’s been more time me and my staff have to make phone calls, trying to see if we’re eligible for our allocation, tracking, going to places where we have these stored and seeing what we have on hand. It’s a lot of counting.”

Looking For Alternatives

Because of the IV bag shortage following Hurricane Maria, Sandlin had to get creative. Patients who could take a pill version of a drug switched from the IV version. Some medications can be pushed into an IV line using a syringe — forgoing the bag entirely. And because Baptist has nine hospitals in Kentucky and southern Indiana, the facilities are borrowing from each other.

The Food and Drug Administration also allowed hospitals to buy IV bags specially imported from Europe to help fill the gaps. In a national update Jan. 16, FDA Commissioner Scott Gottlieb wrote the FDA is approving IV bags from manufacturers that typically don’t import to the U.S. The agency is also asking manufacturers to extend expiration dates on the bags if deemed safe.

“We’ve heard from institutions that only have a few days’ worth of supply on hand; as well as institutions that have to ration diminished stores of these products. We believe that as more supply enters the market these challenges will start to diminish,” Gottlieb wrote.

But the shortage has also caused a near-shortage of other medical supplies …. like large IV bags which typically have different uses than their smaller counterparts.

“Say a hospital couldn’t get the small volumes, then they bought the next big sizes and before you know it threatens all those,” Sandlin said. “We haven’t run out of those either, but we’ve experienced the strain of going through our allocations and we call the manufacturer every day and say, has there been any released, could you send me some from another distribution center.”

A shortage of those large bags would have a bigger affect on patients – because while the small bags are for drugs, the large ones are for fluids to keep patients hydrated.

KentuckyOne’s hospitals in the area are also facing the same problem, though spokesman David McArthur said the shortage hasn’t impacted patients.

“Much credit goes to our pharmacy and supply chain team that have increased efforts to obtain the necessary IV supplies and make sure they are always ready when our front line care givers request them for patients,” McArthur said in an email response.

But an end to the shortage could be coming soon. In the same announcement earlier this week from the Food and Drug Administration, it announced the factories in Puerto Rico are starting to get back online. But Angela Sandlin said she’s still cautious.

“It’s going to take it a while for levels to fill back up so we can have a complete comfort level so every day we’re not looking ahead to the next week to make sure we have supply,” she said.

Shortages Not Uncommon

In addition to the shortage of IV bags, it’s common for health providers to run out of certain drugs or supplies. Sandlin says a big reason for this is because generic drugs are becoming less accessible as drug companies turn to investing in drugs that will make more money.

This is such a problem nationwide that four large hospital systems are forming their own drug company to make generic drugs, as the New York Times first reported on Thursday. The group is lead by Utah-based non-profit hospital group Intermountain Health, and so far, 300 hospitals are included in the group with more expected to join.

“We witness, on a daily basis, how shortages of essential generic medication or egregious cost increases for those same drugs affect our patients,” Intermountain Healthcare CEO Dr. Marc Harrison wrote in a press statement.

The shortages are such a big problem that Baptist Health’s Angela Sandlin said some hospitals have created a position just to track and troubleshoot shortages.

“People have joked that it’s almost a full time job, just keeping track of the shortages and in fact I saw the other day an opening at another health system for a shortage manager,” Sandlin said. “I don’t know if I’d want that job, but I could sure see how you could use it.”